Document Detail


Total Thyroidectomy in Patients with Amiodarone-Induced Thyrotoxicosis and Severe Left Ventricular Systolic Dysfunction.
MedLine Citation:
PMID:  22865896     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context:Patients with amiodarone-induced thyrotoxicosis (AIT) and left ventricular (LV) systolic dysfunction have a high mortality rate. Usually, medical therapy is the first choice for AIT patients, whereas the role of the thyroidectomy is unsettled.Objective:The objective of the study was to evaluate the effect of a total thyroidectomy on cardiac function and survival of AIT patients with severe LV systolic dysfunction.Design:This was a retrospective cohort study.Settings:The study was conducted at a tertiary university center.Patients:All AIT patients (n = 24; nine patients with type 1 AIT, 15 patients with type 2 AIT) referred to the Department of Endocrinology and submitted to a total thyroidectomy at the Department of Surgery, both at the University of Pisa, during the years 1997-2010.Intervention:The intervention was a total thyroidectomy.Main Outcome Measure:LV ejection fraction (EF) after the thyroidectomy and survival in December 2011 were measured.Results:All enrolled patients had previously undergone to medical treatment for AIT, as appropriate, without achieving euthyroidism. Patients with moderate to severe LV systolic dysfunction (EF < 40%, group 1, n = 9) or with mild systolic dysfunction (40% ≤ EF ≤ 50%, group 2, n = 5) were compared with patients with normal systolic function (EF > 50%, group 3, n = 10). Two months after thyroidectomy, under levothyroxine replacement therapy, LVEF improved in patients with LV systolic dysfunction, particularly in those of group 1, in whom it increased from 28.2 ± 7.2 to 38.3 ± 6% (P = 0.007). On the contrary, LVEF did not significantly change in group 3 (from 57.1 ± 3.0 to 59.8 ± 6.6%, P = 0.242). The mean follow-up was 67 ± 42 months. No death occurred during and 2 months after surgery. One death occurred in one patient of group 1, 30 months after the thyroidectomy, due to acute myocardial infarction. No patient had relevant complications of thyroidectomy.Conclusions:Total thyroidectomy, by rapidly restoring euthyroidism, may improve cardiac function and reduce the risk of mortality in AIT patients with severe LV dysfunction.
Authors:
Luca Tomisti; Gabriele Materazzi; Luigi Bartalena; Giuseppe Rossi; Angelica Marchello; Manuela Moretti; Luigi De Napoli; Rita Mariotti; Paolo Miccoli; Enio Martino; Fausto Bogazzi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-3
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Departments of Endocrinology and Metabolism (L.T., A.M., E.M., F.B.) and Surgery (G.M., M.M., L.D.N., P.M.), and Cardio-Thoracic Department (R.M.), University of Pisa, 56124 Pisa, Italy; Department of Clinical and Experimental Medicine (L.B.), University of Insubria, 21100 Varese, Italy; andUnit of Epidemiology and Biostatistics (G.R.), Institute of Clinical Physiology, National Research Council, 56126 Pisa, Italy.
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